Macrolides as antiinflammatory agents in CAP

Abstract

Macrolides are frequently used antibacterials in the treatment of community acquired pneumonia (CAP). Observational data have suggested that macrolide use in CAP is associated with lower mortality and morbidity. Studies in other chronic respiratory conditionshave demonstrated that macrolide antibiotics have anti-inflammatory effects, which extend beyond their antibacterial properties with immunomodulatory effects at multiple stages of the inflammatory cascade, affecting cytokine secretion, inflammatory and structural cells. These may account for some of the benefits seen in observational studies. However the use of macrolides is not without drawbacks; there is growing concern regarding increasing bacterial resistance, tolerability as well as cardiac and aural toxicities. New generation macrolides are being designed to try and overcome these pitfalls by retaining the excellent pharmacokinetics yet providingbetter safety and tolerability profiles. This review will discuss the rationale behind the use of macrolides in CAP, their anti-inflammatory effects and potential pitfalls. Show more